中国城市机构养老服务供需结构的三重失衡

Three Dimensions of Supply-Demand Disequilibria in Aged Care Service in Urban China

发展充分且供需均衡的养老服务体系是应对老龄化挑战的关键。然而,中国城市机构养老服务供需之间表现出三重失衡:主体失衡、价格失衡与功能失衡,形成一种“两头大、中间小”的哑铃型供给匹配“两头小、中间大”的橄榄型需求的结构失衡格局。本文结合A市191家养老机构综合数据与对31位相关人员的深度访谈来探究失衡成因:在需求端,服务诉求与支付能力的攀升使养老需求从低端向更高层次跃迁,而养老金融属性的释放不足使需求聚集于中端;在供给端,公办机构的兜底让位思维与民营机构的逐利避险思维使得养老供给大量集中在低端与高端,而志愿部门由于筹资模式不稳定与“造血”能力不足无力补充中端层次的空白。当前,机构养老供需的结构优化比总量扩张更为迫切。本文系统分析了机构养老服务供需的失衡层次及内在成因,为弥合其中供给与需求的结构断裂提供治理的认识基础。

To cope with the aging population,it's crucial to establish a sound aged care service system with supply-demand equilibrium.However,this is challenged by institutionalized aged care service in urban China.The challenge is embodied in three dimensions:the suppliers,the price,and the function of aged care service.Those disequilibria resulted in the mismatched relationship between a dumbbell-shaped supply structure and an olive shaped demand structure.This paper aims to explore the potential explanations by using two sorts of evidence:(1)a collection of panel data which consists of 191 nursing institutions for the aged in City A in China;(2)in-depth interviews data which involves 31 stakeholders,The findings are summarized as follows.Firstly,the aged prefer the mid-level care service as their quality demand and corresponding affordability are increasing quickly while the financial attributes of aged care service do not perform well.Secondly,the mid-level care service suffers from undersupply due to the preference differences among the private,the public,and the voluntary suppliers.In other words,the private suppliers focus on the high-end service in pursuit of profit maximization,while the public suppliers prefer the minimum standard service,and the voluntary supplier lacks the necessary resources to make up the gap.Therefore,this article advocates a more optimized supply-demand equilibrium of aged service rather than the blind expansion of its scale.The findings above could deepen the understanding of how a sound aged care service system operates 1n practice.